Surgical outcomes for patients who develop macular holes after pars plana vitrectomy

PURPOSE: To characterize outcomes for patients who develop full-thickness macular holes after pars plana vitrectomy. METHODS: We retrospectively analyzed data for 47 consecutive patients (47 eyes) who developed full-thickness macular holes after initial pars plana vitrectomy for a variety of indications. All patients underwent a second vitrectomy and gas tamponade with or without internal limiting membrane peeling. RESULTS: Indications for initial vitrectomy included idiopathic epiretinal membranes (11 eyes), epiretinal membranes with a pseudohole (nine eyes), macular edema resulting from various conditions (nine eyes), proliferative diabetic retinopathy (nine eyes), rhegmatogenous retinal detachment (five eyes), and miscellaneous causes (four eyes). Mean interval from initial vitrectomy to macular hole formation was 20.4 months. Mean visual acuity (VA) in the affected eye was 0.13 (20/155, Snellen equivalent). The hole was closed in 32 eyes (68%) after a single procedure. With a mean follow-up of 53 months, mean final VA improved to 0.26 (20/77); 26 (55%) eyes improved, 18 (38%) were stable, and three (6%) worsened. No severe complications occurred except one macular hole that reopened after successful closure. CONCLUSIONS: Macular holes may develop after pars plana vitrectomy. Although additional vitrectomy can successfully close the hole and improve vision in most patients, postsurgical outcome seems to depend on the underlying condition.     

Ultrastructure of epiretinal membranes associated with macular holes

· Background: The role of tangential traction exerted by epiretinal membranes in the pathogenesis of macular holes is not fully understood. Furthermore, the role of glial cells in the formation and/or closure of macular holes remains to be elucidated. · Methods: To better understand the pathogenesis of macular hole formation and to compare the ultrastructural features of epiretinal membranes associated with macular holes of primary and secondary etiology, we harvested 23 translucent epiretinal membranes associated with macular holes stages III—IV at the time of pars plana vitrectomy and examined them electron microscopically. Eighteen membranes were obtained from patients with idiopathic macular holes, 3 membranes from patients with myopic macular holes and 2 epiretinal membranes were associated with macular holes which had developed after retinal detachment surgery. · Results: Eighteen membranes contained a continuous undulating piece of inner limiting lamina (ILL). Sixteen of 18 epiretinal membranes at the margins of idiopathic macular holes, 2 of 3 membranes in myopic macular holes and both membranes associated with a macular hole after retinal detachment surgery demonstrated mono- or multilayers of fibrous astrocytes with single macrophage- or fibrocyte-like cells. Vitreous and newly formed collagen occupied the space between the ILL and the glial cells. Three macular holes were surrounded by rather firmly attached acellular ILL. · Conclusion: Glial cells and newly formed collagen may play an important role in macular hole formation by exerting tangential traction regardless of the underlying disease process. Glial cells, however, may also be involved in healing of the retinal defect and pars plana vitrectomy with peeling of an epiretinal membrane, and/or the ILL may induce directed glial cell proliferation and migration. The similar ultrastructure of epiretinal membranes associated with macular holes and “simple epiretinal membranes” as described by Foos [8] suggests a common pathogenesis for macular holes and macular pucker. Received: 6 March 1997 Revised version received: 22 July 1997 Accepted: 25 July 1997     

Atypical macular holes

BACKGROUND: Therapeutic strategies for macular holes have been optimised during the last years. However, little is known about atypical macular holes. This study was conducted to analyse the clinical and anatomic outcome in secondary macular holes of different origins. PATIENTS AND METHODS: In a retropective analysis 60 eyes with atypical macular holes that underwent surgical repair were identified. Demografic data, lens status, macular situation, best corrected visual acuity (BCVA) pre- and postoperative and complications were documented. After exclusion of patients with trauma, vitreomacular traction syndrome and epiretinal gliosis four subgroups were analysed. Group I: after retinal detachment (n = 6), Group II: with retinal vein occlusion (n = 5), Group III: associated with diabetic macular oedema (n = 6), Group IV: during/after internal limiting membrane peeling (n = 3). RESULTS: I. Four of six eyes showed a macular hole after successful retinal detachment surgery and two eyes in the presence of retinal detachment. Five of six eyes showed postoperative closure of the macular hole. BCVA improved in four eyes, worsened in one eye and remained unchanged in one. II. In five eyes a secondary macular hole occurred after retinal vein occlusion. After vitrectomy and gas tamponade a successful hole repair was observed in all eyes. Improvement of BCVA occurred in four eyes and remained unchanged in one eye. III. In six eyes a secondary macular hole developed after rupture of cysts in diabetic macular oedema. Four of six holes were closed successfully after vitrectomy. Improvement of BCVA was seen in two eyes, impaired BCVA in one eye and in one eye vision remained unchanged. IV. This group consists of two eyes with a macular hole after vitrectomy and membrane peeling and one eye with an iatrogenic intraoperatively created macular hole. After vitrectomy and gas tamponade, anatomic success was achieved in two eyes. Improvement of BCVA was observed in two eyes, in one eye BCVA deteriorated markedly. CONCLUSIONS: In spite of the different underlying diseases and pathomechanisms, secondary macular holes can be treated successfully in the majority of cases. Visual recovery was moderate in patients with diabetic macular oedema but marked in the other subgroups. Therefore, vitrectomy seems reasonable also in non-atypical macular holes of various origins.     

Optical coherence tomographic findings of macular holes and retinal detachment after vitrectomy in highly myopic eyes

PURPOSE: Macular holes cause retinal detachments in highly myopic eyes. Because degenerative macular changes often coexist, biomicroscopic evaluation of macular hole status after retinal reattachment is sometimes difficult. We studied macular holes with retinal detachment after vitrectomy using optical coherence tomography and evaluated the anatomic status of the hole and factors associated with anatomic success. DESIGN: Retrospective, nonrandomized, comparative study. PATIENTS: Sixteen eyes that underwent vitrectomy for retinal detachment associated with a macular hole were included. Internal limiting membrane peeling with indocyanine green was performed in 14 eyes; the epiretinal membrane was peeled with a diamond-dusted membrane scraper alone in two eyes. All retinas reattached postoperatively. The follow-up period at the optical coherence tomography examination was at least 6 months. METHODS: Optical coherence tomography was performed vertically and horizontally, and the presence of a persistent macular hole was determined. Other information was obtained from patient records. RESULTS: The macular holes closed in seven of 16 eyes (44%). Age, sex, axial length, preoperative best-corrected visual acuity, duration of symptoms, preoperative refractive error, and the preoperative area of the retinal detachment were not significantly correlated with hole closure. Improved postoperative best-corrected visual acuity (P <.05) was significantly associated with macular hole closure, and more frequent visual improvement (P =.06) was of borderline significance. CONCLUSIONS: The success rate was lower than those obtained in eyes without myopia or in myopic macular holes without retinal detachments. Macular hole closure may predict improved visual outcome for patients with retinal detachment and macular holes. Optical coherence tomography detects persistent macular holes in highly myopic eyes with retinal detachment.     

Early postoperative macular features determined by optical coherence tomography after idiopathic macular hole surgery with silicone oil tamponade.

The configuration of idiopathic macular holes in the early postoperative period after pars plana vitrectomy using optical coherence tomography through silicone oil was evaluated. Pars plana vitrectomy with internal limiting membrane peeling and silicone oil instillation was performed on 20 eyes. Optical coherence tomography images were obtained preoperatively and postoperatively. Nineteen eyes (95%) achieved a closed fovea. None of them had a transit foveal contour with flat retina without closure. In the early phase of postoperative idiopathic macular hole repair, inner retinal tissue closure rather than flattening of the fovea is essential for those undergoing pars plana vitrectomy with internal limiting membrane peeling and silicone oil instillation.     

Effects of preoperative and postoperative epiretinal membranes on macular hole closure and visual restoration

OBJECTIVE: To investigate the effects of epiretinal membranes (ERMs) on macular hole surgical results and postoperative visual restoration. DESIGN: A subgroup analysis arising from a multicenter, controlled, randomized clinical trial. PARTICIPANTS: Ninety-one phakic eyes with an idiopathic macular hole that underwent standard vitrectomy for macular hole repair with or without ERM peeling. METHODS: Preoperative, intraoperative, and postoperative data of macular status, ERM status, and visual function status were recorded, and their relationships were analyzed. MAIN OUTCOME MEASURES: Visual acuity and clinical features of macular hole and ERM on baseline examination and scheduled follow-ups. RESULTS: ERM peeling was associated with greater anatomic hole closure success rates (67% of the ERM peeled vs. 35% of nonpeeled, P = 0.03) but not associated with visual improvement in eyes with anatomic hole closure (2.9 lines improvement vs. 3.6 lines improvement, P > 0.5). Macular hole reopening was associated with excessive ERM growth (P = 0.005). Postoperative ERMs were more common in the eyes that underwent cataract surgery after vitrectomy (77% in aphakic and 36% in phakic eyes, P = 0.02). Macular hole edge approximation or hole appearance after initial vitrectomy for hole repair was stable over the average 18-month period in 89% of the eyes; only approximately 10% of the eyes underwent changes in their hole appearance. The hole edge approximation or hole appearance was associated with preoperative hole size and postoperative visual acuity. Preoperative hole size was found to be the major predictor of postoperative visual acuity (P < 0.005). CONCLUSIONS: Surgical ERM peeling increases the anatomic hole closure rate. The presence of postoperative ERMs was not associated with postoperative visual acuity; however, excessive ERM growth contributed to hole reopening. Preoperative hole size was the most sensitive predictor for postoperative visual acuity. Surgical intervention during the early stages of macular hole before ERM formation is strongly recommended.     

Efficacy of internal limiting membrane removal for retinal detachments resulting from a myopic macular hole

PURPOSE: To evaluate the efficacy of internal limiting membrane (ILM) or epiretinal membrane removal during pars plana vitrectomy for a retinal detachment resulting from a macular hole in myopic eyes. METHODS: A retrospective study was conducted in a single institution. Twenty-six highly myopic eyes with a retinal detachment resulting from a macular hole were studied. During pars plana vitrectomy, ILM peeling (ILM-peeled group) was performed on 13 eyes, and the ILM was not removed (ILM-preserved group) in 12 eyes. Main outcome measures were anatomic reattachment, optical coherence tomography-determined macular hole closure, and visual acuity. Follow-up periods were longer than 12 months in all cases. RESULTS: The anatomic reattachment rate after the initial surgery was significantly higher in the ILM-peeled group (92.3%) than in the ILM-preserved group (50%). The macular holes of 8 (72.7%) of the 11 ILM-peeled and reattached eyes and 2 (50%) of the 4 ILM-preserved and reattached eyes were successfully closed by the initial surgery. No significant difference was found in the postoperative visual acuity and the improvement of visual acuity between the ILM-peeled group and the ILM-preserved group. There was also no significant difference of the postoperative visual acuity and improvement of the visual acuity between the two groups in cases with an initial anatomic success. CONCLUSION: These results indicate that removal of the ILM contributes to a successful reattachment and is an effective treatment for macular hole and retinal detachment in highly myopic eyes. The authors suggest that the higher success rate after ILM peeling resulted from the release of the traction of the prefoveal vitreous and the epiretinal membrane over the detached retina.     

玻璃体切除和自体血小板治疗特发性黄斑裂孔

目的评价玻璃体切除、浓缩自体血小板和气体眼内填充治疗全层特发性黄斑裂孔的效果。方法对6例全层特发性黄斑裂孔患者的6只眼采用玻璃体切除，剥除玻璃体后皮质，气液交换，自体血小板溶液滴于后极部，20%～30%SF6注入玻璃体腔的方法进行治疗。术后患者仰卧1小时，然后俯卧2周。结果手术后9天～12个月6只眼黄斑裂孔闭合，视网膜平复。视力改善2行以上5只眼，占83.3%，视力达到0.3以上者4只眼，占66.7%，1只眼发生周边视网膜新裂孔伴视网膜脱离。结论玻璃体切除、浓缩自体血小板和气体眼内填充可使全层特发性黄斑裂孔闭合，视力提高。(中华眼底病杂志,1998,14:14-15)     

Macular hole surgery with internal-limiting membrane peeling and intravitreous air

ObjectiveTo examine the results of macular hole surgery using pars plana vitrectomy, internal-limiting membrane peeling, and intravitreous air in a series of consecutive patients.DesignA retrospective, interventional, noncomparative case series.PatientsFifty consecutive patients (58 eyes) with full-thickness macular holes.InterventionAll eyes underwent a pars plana vitrectomy with internal-limiting membrane peeling and intravitreous air, and patients were asked to position face-down for only 4 days.Main outcome measuresStatus of macular holes, visual acuity, and associated findings and complications.ResultsAll patients had postsurgical follow-up of 6 months or greater. Eight eyes (14%) presented with stage-2 macular holes, 48 eyes (83%) with stage-3 macular holes, and 2 eyes (3%) with stage-4 macular holes. Only 26 eyes (45%) had a macular epiretinal membrane seen before surgery. Fifty-three (91%) of the 58 macular holes were closed with 1 operation, and 55 (95%) had closure of the macular holes with subsequent operations. Five (9%) of 58 eyes had an initial visual acuity of 20/50 or better, and 31 eyes (53%) had a final visual acuity of 20/50 or better. Of the 45 eyes with symptoms of less than 6 months’ duration, 44 (98%) had macular holes that were closed with 1 operation and 27 (60%) had a final visual acuity of 20/50 or better. Of the 13 eyes with symptoms of 6 months’ duration or longer, 9 (69%) had macular holes that were closed with 1 operation and 4 (31%) had a final visual acuity of 20/50 or better. Complications attributed to the operation included retinal tears, retinal detachments, postoperative macular puckers, and macular light toxicity.ConclusionsThe anatomic and visual results in this series are good. The current technique is similar to that of conventional macular hole surgery except for the use of intravitreous air, internal-limiting membrane peeling in all eyes, and only 4 days of postoperative positioning. This study would suggest that peeling of the internal-limiting membrane is an important adjuvant for successful closure of macular holes.     

Exudative retinal detachment in macular hole surgery using platelet concentrates – a case report

INTRODUCTION: Retinal detachment after macular hole surgery is a rare complication, usually occurring because of small, peripheral holes. We present a patient with a high bullous exudative retinal detachment following pars plana vitrectomy. CASE REPORT: A healthy 69-year-old patient presented with a macular hole stage III of the left eye. Corrected visual acuity was 20/200. Pars plana vitrectomy was performed without peeling of the internal limiting membrane or an epiretinal membrane, a few drops of platelet concentrate were instilled onto the hole, and the bulbus was filled subtotally with a non-expanding SF6/air mixture. On the 3rd postoperative day a small retinal detachment of the inferior half of the retina was noticed that increased over the next 3 days until it reached the inferior vascular arcade. During the following 3 days a spontaneous remission occurred with complete reattachment of the retina. Six weeks after operation the retina was completely reattached, the macular hole was closed, and the visual acuity was 20/200 with a slight cataract. CONCLUSION: Retinal detachments after macular hole surgery are not always of rhegmatogenous nature but may also be exudative and related to an inflammatory reaction caused by adjuvants. When a retinal detachment occurs immediately after macular hole surgery without detectable holes it may be advisable to wait for some days before reoperation.     

Macular hole surgery in high myopia

PURPOSE: To evaluate the anatomic and functional outcomes of macular hole surgery in high myopia and to determine whether surgery is beneficial in myopic eyes with macular holes. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Twenty eyes of 18 highly myopic subjects who underwent pars plana vitrectomy for macular holes. METHODS: We analyzed demographics, preoperative, and postoperative characteristics in 20 eyes with macular holes with a mean of 10.4 months duration and myopia of 6 diopters or greater. MAIN OUTCOME MEASURES: Macular hole closure rate and mean visual acuity preoperatively and postoperatively. RESULTS: Mean subject age was 56.4 years and preoperative visual acuity was 20/100+2. The macular hole was closed with one surgery in 60.0% of eyes and in 85.0% of eyes with one or more surgeries. The mean final acuity in all eyes was 20/63, and 40.0% improved greater than three Snellen lines at the final visit. The use of adjunctive agents seemed to have no effect on macular hole closure or visual acuity. A subgroup of three myopic eyes with retinal detachments surrounding the macular hole had successful closure with visual acuity improvement in two of three eyes. CONCLUSIONS: Macular hole surgery can give substantial visual improvement in myopic eyes with macular holes, but the anatomic closure rates are lower than in eyes with idiopathic macular holes, and thus a higher reoperation rate is required.     

Reopening of previously closed macular holes after cataract extraction

PURPOSE: To evaluate the frequency of reopening of macular holes after cataract extraction. DESIGN: Retrospective, comparative, consecutive case series. METHODS: Two hundred and eleven eyes with idiopathic macular holes closed by vitrectomy were divided into four groups: Group 1: prior cataract extraction; Group 2: vitrectomy then cataract extraction; Group 3: vitrectomy only; and Group 4: vitrectomy and cataract extraction as a combined procedure. The main outcome measure of macular hole reopening was evaluated in relationship to multiple variables. RESULTS: Two hundred and eleven eyes were included: Group 1: 56 eyes; Group 2: 86 eyes; Group 3: 41 eyes; and Group 4: 28 eyes. Twenty-four macular holes reopened (11%) (mean follow-up 26.6 months, range, three to 118 months). The greatest number of macular hole reopenings, 17 (20%), were in Group 2. Cox multivariate analysis failed to demonstrate an association between duration of hole, serum use, internal limiting membrane peeling, or stage and reopening of a macular hole. Cox analysis showed a four-fold increased risk of reopening in Group 2 eyes (95% confidence interval [CI]: 1.7 to 11.2; P = .002). Eyes with cystoid macular edema after cataract extraction had a seven-fold increased risk of macular hole reopening (7.72; 95% CI: 2.79 to 21.3; P < .0005). Kaplan-Meier analysis showed increased rates of macular hole reopening in Group 2 eyes compared to the other 3 groups combined (log-rank P < .00005). CONCLUSIONS: Cataract extraction after successful vitrectomy for macular hole, when complicated by cystoid macular edema (CME), may increase the risk of macular hole reopening.     

Adjuvant methods in macular hole surgery: intraoperative plasma-thrombin mixture and postoperative fluid-gas exchange

BACKGROUND AND OBJECTIVE: The optimal method for surgical management of idiopathic macular holes remains unknown. Adjuvant methods including intraoperative cytokines and postoperative fluid-gas exchange with and without laser have been described. We report on the safety and final results of routine intraoperative autologous plasma-thrombin mixture and postoperative fluid-gas exchange when necessary as an adjunct to the surgical therapy of this disease. PATIENTS AND METHODS: A consecutive series of 114 patients (mean age 66.9 years) with primary idiopathic full thickness Stage II, III, and IV macular holes were primarily treated by vitrectomy, fluid/perfluorocarbon gas exchange, and application of autologous plasma-thrombin mixture to the macular hole. Visible epiretinal membranes were peeled but the normal appearing internal limiting membrane was not routinely stripped. Outcome measures included final Snellen visual acuity, rate of macular hole closure, complications, and number of supplemental procedures performed. RESULTS: Closed at one month, were 110 of 121 (91%) macular holes, including two that underwent repeat fluid/gas exchange and laser within the first two weeks after surgery. At the time of final follow-up (mean: 10.9 months), 110 of 121 (91%) macular holes were closed. This included 8 of 9 eyes that had reopening of the macular hole between one and 21 months successfully treated by repeat fluid-gas exchange and 2 eyes that underwent a second successful pars plana vitrectomy, membrane peeling, and repeat fluid-gas exchange. Overall, 98 of 121 eyes overall (81%) were successfully treated by a single surgery; 94 of 121 (78%) achieved two lines or greater of visual improvement; 83 of 121 (69%) achieved 20/70 or better vision; and 47 eyes (39%) achieved 20/40 or better vision. Complications in this series included infectious endophthalmitis (1 eye), intraoperative retinal break (2 eyes), late retinal detachment (5 eyes), transient mild intraocular pressure elevation (46 eyes), inflammatory response (six eyes), epiretinal membrane (6 eyes), intraretinal hemorrhages (1 eye), and cataract (33 of 99 phakic eyes underwent cataract extraction during the follow-up). CONCLUSION: A combination of intravitreal perfluorocarbon gas and autologous plasma-thrombin mixture (tissue glue) was well tolerated in most patients and did not result in any specific long-term complications. The use of supplemental fluid-gas exchange when necessary improved the final success rate. Further well-controlled and randomized studies will be required to determine the efficacy of this as an adjunct or alternative to other methods of treatment for macular holes.     

Treatment by internal tamponade of retinal detachment with a macular hole

The authors analyse the operative results of 92 cases of retinal detachment with macular hole, treated by internal tamponade, since 1976. Three technics were used: vitrectomy + silicone oil injection (75 cases), vitrectomy + SF6 gas injection (9 cases), intra-ocular liquid suction + SF6 gas injection (8 cases). Silicone vitrectomy is particularly advisable in the case of large, old retinal detachment with proliferative vitreoretinopathy. This form of treatment is imperative when there is no hope of a satisfactory postoperative positioning, or after an unsuccessful gas treatment due to epiretinal macular membrane. Suction gas is a new and simple technique which is recommended when the macular hole is isolated and without epiretinal membranes. A lattice pattern argon-laser retinopexy is performed, by means of a series of laser impacts at the posterior pole, up to the edge of the macular hole. Treatment of isolated macular holes in a flexible retina by silicone vitrectomy achieved a 78.5% success rate; suction + gas achieved a similar success rate; this last method appears to be the ideal first choice for most of the cases, i-c the two failures which were subsequently turned into successes by silicone vitrectomy.     

Macular changes after peeling of the internal limiting membrane in macular hole surgery

PURPOSE: To report the incidence of macular changes following pars plana vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular hole. DESIGN: Prospective consecutive series. METHODS: In a prospective study 105 eyes of 105 patients underwent vitrectomy for idiopathic macular holes. Surgery consisted of a standard three-port vitrectomy, induction of a posterior hyaloid detachment, removal of epiretinal membranes including the ILM, fluid-air exchange and intraocular gas tamponade (15% hexafluoroethane (C2F6) gas mixture) followed by head-down positioning for at least five days. No adjuvants were used during surgery. In addition to the clinical examination, static microperimetry using a Rodenstock scanning laser ophthalmoscope (SLO-105) was performed pre- and 6 or 12 weeks postoperatively. The stimulus size was 0.2 degrees (Goldmann II), intensities employed were 0 and 12 dB. For all tests, 20-degree fields were used. RESULTS: Anatomic closure of macular holes was achieved in 92 (87.6%) of 105 patients by one operation. Eight patients underwent a successful second procedure. The closure rate after two operations was 95.2%. Best corrected visual acuity increased from a median of 0.2 (range 0.05 to 0.5) preoperatively to a median of 0.5 (range 0.05 to 1.0) postoperatively. Anatomical macular changes were found in 8 (7.6%) patients: There were two cases of macular edema following secondary cataract extraction and six cases of retinal pigment epithelium changes. Formation of postoperative epiretinal membranes or late reopenings were not noted. Small, mostly asymptomatic paracentral scotomata were seen in 59 (56.2%) of 105 patients. CONCLUSION: Anatomical changes of the macula following vitrectomy with removal of the ILM are infrequent. However, paracentral scotomata observed in our series might be caused by a trauma to the nerve fibers during ILM peeling. To achieve reliable results a standardized procedure for microperimetry should be developed.     

The role of vitreoretinal surgery in the management of myopic macular hole without retinal detachment

PURPOSE: To evaluate the anatomic and functional outcome of vitreoretinal surgery in eyes with pathologic myopia and macular hole and to determine if surgery improves visual acuity. METHODS: Twenty-four consecutive highly myopic eyes with full-thickness macular hole without posterior retinal detachment were treated by vitrectomy. Posterior hyaloid dissection, removal of epiretinal and internal limiting membranes (ILM) if thickened, instillation of platelet concentrate, and flushing with 25% sulfur hexafluoride were performed. RESULTS: Patients' refractive error ranged between -8.0 and -17.5 diopters, and axial length ranged from 27.1 to 31.4 mm. Two epimacular membranes and 10 macular ILM were removed. Ten patients also underwent phacoemulsification and intraocular lens implantation at the same procedure. Mean preoperative best-corrected visual acuity was 20/200. Successful anatomic macular hole closure occurred 6 months postoperatively in 100% of eyes after one (21 eyes, 87.5%) or two surgeries (3 eyes, 12.5%). Visual acuity improved three or more lines in 83.3% of patients. Mean postoperative visual acuity was 20/70. No retinal detachment was observed during the follow-up period, which ranged from 12 to 45 months. CONCLUSION: Our results suggest that vitreoretinal surgery may effectively manage myopic macular holes, thus improving anatomic and visual outcomes. By closing the hole, vitreoretinal surgery may decrease the risk of posterior retinal detachment in highly myopic eyes.     

Results of macular hole surgery with and without epiretinal dissection or internal limiting membrane removal

PURPOSE: To evaluate the results of idiopathic macular hole surgery with or without epiretinal dissection or peeling of the internal limiting membrane (ILM). DESIGN: Retrospective consecutive nonrandomized comparative interventional trial. PARTICIPANTS: One hundred seventy-two eyes of 162 patients with previously untreated idiopathic macular holes of <24 months duration. INTERVENTION: All eyes were treated with pars plana vitrectomy by 1 surgeon using 1 of 3 techniques: no epiretinal dissection (116 eyes), epiretinal dissection (27 eyes), or ILM peeling (29 eyes). MAIN OUTCOME MEASURES: Closure of the macular hole and visual acuity. RESULTS: The macular hole was closed with 1 surgery in 92.9% of 56 eyes with epiretinal dissection/ILM peeling versus 79.3% of 116 eyes without dissection (P = 0.03) and was closed with 1 surgery in 85.1% of 27 eyes in the epiretinal dissection group compared with 100% of 29 eyes in the ILM peeling group (P = 0.05). Visual acuity improved 3 or more lines in 57.1% of 56 eyes in the epiretinal dissection/ILM peeling group compared with 38.8% of 116 eyes in the no dissection group 3 months postoperatively (P = 0.03). Visual acuity improved 3 or more lines at 3 months in the no dissection group in 32.2% of 87 eyes placed faceup for 24 hours compared with 58.6% of 29 eyes placed immediately prone postoperatively (P = 0.02). The visual and anatomic results of the no dissection and epiretinal dissection/ILM peeling groups were similar when comparing eyes in the no dissection group placed immediately prone with the epiretinal dissection/ILM peeling eyes also placed immediately prone. Visual improvement of 3 or more lines at 3 months occurred in 79.2% of 24 eyes in the epiretinal dissection group versus 44.8% of 29 eyes in the ILM peeling group (P = 0.01) in eyes with successful macular hole closure. Visual acuity results were similar in all subgroups at the final examination after reoperations. CONCLUSIONS: The faceup position for 24 hours using adjuvants reduced the initial anatomic and visual outcomes of macular hole surgery. Internal limiting membrane peeling improved the likelihood of successful macular hole closure but reduced the amount of initial visual improvement at 3 months compared with epiretinal dissection alone. Final visual acuities were similar in all groups.     

高度近视黄斑裂孔性视网膜脱离的再次手术

目的 评价高度近视黄斑裂孔性视网膜脱离再次手术的治疗效果。方法 对需再次手术的黄斑裂孔性视网膜脱离17例17眼，其中11例是第1次经玻璃体切割联合膨胀气体填充后黄斑裂孔未闭合，6例是黄斑裂孔闭合后晚期复发的患者行玻璃体切割，彻底黄斑前膜剥离，2例行视网膜内界膜剥离，全部病例联合硅油内填充，11例术后补充氩激光光凝。结果 17例17眼黄斑裂孔闭合，视网膜全部复位，最终视力较术前提高。随访3—24个月，视网膜复位良好，无1眼复发。结论 黄斑裂孔性视网膜脱离再次手术中彻底剥离黄斑前膜，剥离视网膜内界膜，硅油填充和激光光凝可有效封闭黄斑裂孔。     

Relationship between macular hole size and the potential benefit of internal limiting membrane peeling

AIM: To investigate the relationship between the size of macular holes and the possible benefit of internal limiting membrane (ILM) peeling. METHODS: 84 consecutive cases of idiopathic macular hole followed up for at least 3 months were included in this retrospective study. Surgery comprised pars plana vitrectomy, peeling of any epiretinal membrane, 17% C2F6 (hexafluoroethane) gas filling and 10 days of positioning. 36 eyes had ILM peeling. The main outcome measure was the macular hole closure rate checked by optical coherence tomography. RESULTS: The overall postoperative closure rate was 90.5%. For macular holes > or =400 microm in diameter, the rate was 100% with ILM peeling versus 73.3% without (p = 0.015). For smaller macular holes, the rates were 100% in both groups. Postoperative gain in visual acuity was not significantly different in eyes with ILM peeling and those without. CONCLUSIONS: ILM peeling does not seem to be useful for macular hole <400 mum in diameter. Its likely benefit has to be investigated for larger macular hole sizes, for which the failure rate is higher.     

玻璃体切除联合C3F8混合气体或硅油填充治疗黄斑裂孔性视网膜脱离

目的:观察现代闭合玻璃体切除联合C3F8混合气体或硅油填充治疗黄斑裂孔性视网膜脱离的效果。方法:利用常规闭合玻璃体切除联合C3F8混合气体或硅油填充方法治疗19例19眼高度近视性黄斑裂孔性视网膜脱离患者,术后观察视力、眼压及眼底黄斑裂孔闭合情况。结果:黄斑裂孔闭合情况:19例黄斑裂孔全部闭合,视网膜复位良好;随访4mo时,未见裂孔复发需再次手术修补者。术后随访4～12mo,未发现白内障病情进展。视力和眼压:手术后患者视力提高2行以上者6例(32%),不变13例(68%)。术后1mo内检测眼压,发现仅有1例(5%)眼压升高,给予局部降眼压药后眼压降至正常。结论:现代闭合玻璃体切除联合C3F8混合气体或硅油填充方法治疗黄斑裂孔性视网膜脱离具有较好的疗效。